2022-08-29T16:14:08-05:00 2021-12-31 621142155 PUGH & COMPANY PC 315 N CEDAR BLUFF RD SUITE 200 KNOXVILLE TN 37923 990PF 2021-01-01 204901729 LAFOLLETTE MEDICAL FOUNDATION INC LAFO 4239126963 PO BOX 128 JACKSBORO TN 37757 STACY WOOD-HEATHERLY PRESIDENT 4239126963 2022-08-17 1 STACY WOOD-HEATHERLY 999009999 KELLY A TUCKER CPA P01015909 8657690660 2022-08-16 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z X 11327212 X 0 X 53 53 197589 197589 742788 2876442 742788 38704 940430 940430 38704 0 0 0 5143 3857 1286 15305 10220 5085 71873 71873 0 15033 3481 0 22751 9000 13852 130105 98431 20223 683056 721760 813161 98431 741983 127269 841999 38704 647918 669412 669412 803751 1004129 1004129 8826030 9130934 9130414 582923 515295 515295 6932 7962 7962 10867554 11327732 11327212 20000 8000 3180 5320 23180 13320 X 10844374 11314412 10844374 11314412 10867554 11327732 10844374 127269 342769 11314412 0 11314412 LT - PUBLICLY TRADED SECURITIES HELD IN BROKERAGE ACCOUNT 2248300 1513125 735175 735175 ST - PUBLICLY TRADED SECURITIES HELD IN BROKERAGE ACCOUNT P 628142 620529 7613 7613 742788 11704 0 11704 0 11704 6480 0 15000 0 21480 0 9776 9776 0 0 0 0 0 0 0 0 0 0 0 1 1 TN 1 0 0 0 0 1 WWW.LAFOLLETTEMEDICALFOUNDATION.ORG JUNE WILBURN 4239126963 905 RIVERVIEW DRIVE LAFOLLETTE TN 37766 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 DR JAMES FARRIS PO BOX 128 JACKSBORO TN 37757 DIRECTOR 1.00 0 0 0 DR DEBRA AYERS NELSON PO BOX 128 JACKSBORO TN 37757 DIRECTOR 1.00 0 0 0 TRACI CHAMBERS PO BOX 128 JACKSBORO TN 37757 DIRECTOR 1.00 0 0 0 MAYOR MIKE STANFIELD PO BOX 128 JACKSBORO TN 37757 PRESIDENT 1.00 0 0 0 DR RICHARD BURDEAUX PO BOX 128 JACKSBORO TN 37757 DIRECTOR 1.00 0 0 0 STACEY WOOD-HEATHERLY PO BOX 128 JACKSBORO TN 37757 SECRETARY 1.00 0 0 0 MICHEAL E WALDEN PO BOX 128 JACKSBORO TN 37757 TREASURER 1.00 0 0 0 NONE 0 NONE 0 0 10553671 731208 0 11284879 0 0 11284879 169273 11115606 555780 555780 11704 11704 544076 38704 582780 0 582780 741983 0 741983 582780 0 0 3250 7218 35051 103417 148936 741983 0 0 0 582780 159203 0 0 308139 0 0 0 0 0 0 0 308139 3250 7218 35051 103417 159203 LAFOLLETTE MEDICAL FOUNDATION PO BOX 128 JACKSBORO TN 37757 4239126963 GRANTS@LAFOLLETTEMEDICALFOUNDATION.ORG PLEASE VISIT THE ORGANIZATION'S WEBSITE AT WWW.LAFOLLETTEMEDICALFOUNDATION.ORG TO OBTAIN THE GRANT APPLICATION NONE IN ORDER TO BE ELIGIBLE FOR A GRANT FROM THE FOUNDATION, AN ORGANIZATION MUST QUALIFY FOR EXEMPTION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND MUST NOT BE A PRIVATE FOUNDATION AS DEFINED BY SECTION 509(A) OF THE CODE, OR IT MUST BE A PUBLIC INSTRUMENTALITY. GRANTS MAY NOT BE MADE TO INDIVIDUALS. THE FOUNDATION MAY MAKE GRANTS TO ORGANIZATIONS PROVIDING SERVICES TO CAMPBELL COUNTY, TN RESIDENTS FOR THE FOLLOWING PURPOSES: HEALTH SERVICES, PREVENTATIVE ILLNESS, CHILDREN HEALTH AND WELL-BEING, SENIOR SAFETY AND WELLNESS AND ANY HEALTH PROGRAM THAT HAS MERIT AND IS RELATED TO THE FOUNDATION'S MISSION AND OBJECTIVES. CAMPBELL COUNTY BOARD OF EDUCATION 172 VALLEY STREET JACKSBORO TN 37757 NONE GOVERNMENT AGENCY INFLUENZA VACCINATION PROGRAM, JELLICO HIGH SCHOOL ATHLETIC PERSONAL TRAINER 60850 CAMPBELL COUNTY CHILDREN'S CENTER 203 INDEPENDENCE LANE LAFOLLETTE TN 37766 NONE 501(C)(3) HEALTH EDUCATION/PREVENTION PROGRAM 42223 CAMPBELL COUNTY RURAL FIRE SERVICE 4422 VICTORY ROAD LAFOLLETTE TN 37766 NONE 501(C)(3) FIRE PROTECTION FOR CAMPBELL COUNTY 32091 CAMPBELL COUNTY SENIOR CITIZENS 102 8TH STREET LAFOLLETTE TN 37766 NONE 501(C)(3) HOME DELIVERED MEALS FOR ELIGIBLE SENIORS 70200 CASA OF CAMPBELL COUNTY PO BOX 1054 JACKSBORO TN 37757 NONE 501(C)(3) VOLUNTEER OUTREACH SERVICES 20000 CATHOLIC CHARITIES OF EAST TENNESSEE 3009 LAKE BROOK BLVD KNOXVILLE TN 37909 NONE 501(C)(3) PREGNANCY HELP CENTER 22000 CITY OF LAFOLLETTE FIRE DEPARTMENT 105 E BEECH STREET LAFOLLETTE TN 37766 NONE GOVERNMENT AGENCY FIRE PROTECTION FOR THE CITY OF LAFOLLETTE 76055 COMMUNITY HEALTH OF EAST TENNESSEE PO BOX 209 507 MAIN STREET JACKSBORO TN 37757 NONE 501(C)(3) DRUG COURT PROGRAM, GENERATION X, PATIENT CARE 79940 CARYVILLE- FIRE DEPARTMENT 4839 OLD TENNESSEE 63 CARYVILLE TN 37714 NONE 501(C)(3) CARYVILLE FIRE DEPARTMENT 45957 EAST TENNESSEE HUMAN RESOURCES AGENCY 9111 CROSS PARK DR STE D10 KNOXVILLE TN 37766 NONE 501(C)(3) SENIOR SAFETY AND WELLNESS SUPPORT 30000 FOOD LIFE SERVICES OF CAMPBELL COUNTY 206 S INDIANA AVENUE LAFOLLETTE TN 37766 NONE 501(C)(3) EXPANDED NUTRITIONAL DISTRIBUTION 5000 LAFOLLETTE RESCUE SQUAD 222 FIRE RESCUE LN LAFOLLETTE TN 37766 NONE GOVERNMENT AGENCY RESCUE PREPAREDNESS PROJECT 8444 OPEN ARMS MINISTRY PO BOX 433 CARYVILLE TN 37714 NONE 501(C)(3) FEEDING THE NEEDIEST OF CAMPBELL COUNTY 60000 PINNACLE RESOURCE CENTER 507 MAIN ST JACKSBORO TN 37757 NONE 501(C)(3) HELP PROVIDE INDIVIDUALS FACING HOMELESSNESS WITH THE TOOLS AND RESOURCE TO GET BACK ON THEIR FEET 30000 REMOTE AREA MEDICAL INC 2200 STOCK CREEK BLVD ROCKFORD TN 37853 NONE 501(C)(3) PROVIDE FREE QUALITY HEALTHCARE TO THOSE IN NEED 19000 SPRINGS OF LIFE RECOVERY CENTER PO BOX 893 JELLICO TN 37762 NONE 501(C)(3) RECOVERY CENTER FOR MEN 120000 721760 0 14 53 14 197589 18 742788 0 940430 0 940430 0 0 0 0 0 0 0 0 0 0 ACCOUNTING FEES 15305 10220 5085 DETAIL INFO REQUEST FORM 990 PF, PART II, LINE 10B AND LINE 10C THE INSTRUCTIONS FOR FORM 990-PF REQUIRE A SCHEDULE THAT LISTS EACH SECURITY HELD AT THE END OF THE YEAR, AND TO SHOW WHETHER THAT SECURITY IS REPORTED AT COST BASIS OR FMV. ALL SECURITIES ARE HELD IN A BROKERAGE ACCOUNT THROUGHOUT THE YEAR AND ARE REPORTED AT FMV. THIS SCHEDULE CAN BE PROVIDED TO THE IRS AT THEIR REQUEST. UBS #KAXX118 (HELD IN BROKERAGE A/C DETAIL AVAILABLE UPON REQUEST) 515295 515295 UBS #KAXX118 (HELD IN BROKERAGE ACCOUNT - DETAIL AVAILABLE UPON REQUEST) 9130934 9130414 1004129 1004129 0 0 LEGAL FEES 5143 3857 1286 ACCRUED INTEREST RECEIVABLE 6932 7962 7962 INSURANCE 2632 0 2632 OFFICE EXPENSES 2119 0 2220 CONTRACT LABOR 18000 9000 9000 UNREALIZED GAIN 342769 TAXES PAYABLE 3180 5320 UBS FEES 71873 71873 0 FEDERAL EXCISE TAX 11552 0 0 FOREIGN TAX WITHHOLDING 3481 3481 0